Fig. 3.

Postoperative period. (A) Patient in the initial postoperative period performing partial load with the aid of crutches. (B) The period of gradual opening is started with 1/4 turn of the compression-distraction unit every 6 hours. Initially, the external fixator is opened without the connection between the accessory pin to the fixators pins. When we observe that the epiphyseal deformity was corrected, we installed the accessory bar and connected it with the accessory pin and with the fixator’s proximal pins, locking the opening of the proximal osteotomy. (C) After the distal osteotomy has been opened, correcting the metaphyseal deformity, or if we observe the correction of the metaphyseal deformity first, we block the distal osteotomy, connecting the bar to the accessory pin and the distal pins of the fixator. (D) The two osteotomies consolidated and the lower limb aligned. (E) Observation of sequential and gradual correction of severe deformity of neglected Blount disease. (F) Preoperative and postoperative picture of a patient with both sides already operated not simultaneously. (G) Right leg after the controlled double gradual opening osteotomy, right knee before the treatment. Left knee before the treatment, left leg after the controlled double gradual opening osteotomy.